1 September 2011 to 31 August 2012
CervicalCheck Programme Report 1 September 2011 to 31 August 2012
The National Cancer Screening Service is part of the Health
Service Executive. It encompasses BreastCheck – The National
Breast Screening Programme, CervicalCheck – The National
Cervical Screening Programme, BowelScreen – The National
Bowel Screening Programme and Diabetic RetinaScreen – The
National Diabetic Retinal Screening Programme
QA - CS/PR/PM-17 Rev 1
ISBN number: 978-1-907487-14-9
Programme
Report
CervicalCheck Charter
Screening commitment:
We aim:
• CervicalCheck – The National
Cervical Screening Programme
offers a free complete quality
assured programme of care
• To ensure pleasant and
comfortable surroundings during
screening.
• You choose your smeartaker from
a wide range of eligible service
providers registered with the
Programme
• You may change your preferred
provider for subsequent
Programme screening
• All Programme staff will respect
your privacy, dignity, religion,
race and cultural beliefs
• Your screening records will be
treated in the strictest confidence
• You will always have the
opportunity to make your views
known and to have them taken
into account
• Once you become known to the
Programme you will be invited
every three years for screening
while you are aged 25 to 44 and
every five years while you are
aged 45 to 60
• Your smear test will be screened
in an accredited quality assured
laboratory
• Your result and any treatment
recommendation will be provided
to you and your nominated
smeartaker by the Programme
within four weeks.
If you require further
treatment, we aim:
• To ensure that you will be offered
an appointment at a quality
assured colposcopy clinic (within
four weeks for high grade cell
changes and within eight weeks
for low grade cell changes).
Tell us what you think:
• Your views are important to us
in monitoring the effectiveness
of our services and in identifying
areas where we can improve
• You have a right to make your
opinion known about the care
you received
• If you feel we have not met the
standards of this Charter, let
us know by telling the people
providing your care or in writing
to the Programme
• We would also like to hear from
you if you feel you have received
a good service. It helps us to
know that we are providing the
right kind of service – one that
satisfies you.
• Finally, if you have any
suggestions on how our service
can be improved, we would be
pleased to see whether we can
adopt them to further improve
the way we care for you.
Ways you can help us:
• Please make your appointment
with a registered smeartaker on
receipt of your invitation letter
from the Programme
• Please bring your PPS number
with you to your appointment
• Please read any information we
send you
• Please try to be well informed
about your health.
Let us know:
• If you change your address
• What you think – your views are
important.
Freephone 1800 45 45 55
www.cervicalcheck.ie
Contents
CervicalCheck Charter
1
Outline of The National Screening Service
3
Overview and introduction to CervicalCheck programme report
4
Updates5
Completion of the first five years of CervicalCheck 6
Primary care
6
Smeartaker supports and training
Promoting regular smear test as a routine health behaviour
Cytology services
Colposcopy services
10
Histology services
12
7
8
9
Programme statistics
14
Glossary 35
The National Screening Service
The National Screening Service (NSS) was part
of the Health Service Executive National Cancer
Control Programme during the fourth year of the
CervicalCheck programme 1 September 2011 to
31 August 2012. The National Screening Service
has responsibility for four population-based
screening programmes in Ireland:
• BreastCheck – The National Breast Screening
Programme which offers women aged 50-64
(over 360,000 women) a free mammogram every two years and commenced screening from February 2000. www.breastcheck.ie
• CervicalCheck – The National Cervical Screening
Programme which offers free smear tests to
women aged 25 to 60 (over 1.1 million women).
Regular smear tests at recommended intervals
can prevent cervical cancer. Since CervicalCheck
launched in September 2008, almost 1.65 million
smear tests have been processed for more than
875,000 women. www.cervicalcheck.ie
• BowelScreen – The National Bowel Screening
Programme, for the early detection of bowel
cancer in men and women aged 55 to 74 (over
one million people). The programme is initially
aimed at people aged 60 to 69 years (500,000)
and the first round began in late 2012 and may
take up to three years to complete, after which
each round should be completed in two years.
www.bowelscreen.ie
• Diabetic RetinaScreen – The National Diabetic
Retinal Screening Programme, for the early
detection of diabetic retinopathy is aimed at
all people with Type 1 or Type 2 diabetes aged
12 and over (approximately 190,000 people).
The programme, which commenced its first
round in early 2013, signalled the expansion
for NSS into non-cancer related conditions and
is a population-based call, re-call screening
programme.
3
When all four population-based screening
programmes are fully operational, over two million
people in Ireland will be eligible to participate in
one or more of the programmes.
The National Screening Service has a commitment
to implement special measures to promote
participation in its programmes by harder-to-reach
individuals and communities within the population.
The National Screening Service is dedicated to
continued delivery of screening programmes,
sharing expertise and learning across national
screening programmes and driving effectiveness
through strengthening the single governance
model in place for screening.
Background
NSS, formerly the National Cancer Screening
Service (NCSS), was established in January 2007
following the launch of ‘A Strategy for Cancer
Control in Ireland 2006’ by the Cancer Control
Forum and the Department of Health, which
advocated a comprehensive cancer control
policy programme in Ireland. The strategy set
out recommendations regarding the prevention,
screening, detection, treatment and management
of cancer in Ireland. It recommended the
establishment of the National Cancer Screening
Service Board, which was later dissolved when the
NCSS joined the Health Service Executive National
Cancer Control Programme (NCCP) in 2010.
THE NATIONAL SCREENING SERVICE
Overview and introduction to
CervicalCheck programme report
This report contains screening statistics for the
fourth year of operation (1 September 2011 to
31 August 2012) and an overview of activity and
developments within CervicalCheck up to the
time of publication.
CervicalCheck is central to cervical cancer
prevention in Ireland, working to reduce incidence
and mortality from the disease by detecting
changes in the cells of the cervix before they
become cancerous. The annual average incidence
of cervical cancer in Ireland during 2008-2010 was
308 cases with 88 deaths due to the disease in
2010.1 With an eligible population of over 1.1 million
women aged 25 to 60, CervicalCheck has the
potential to reduce mortality from cervical
cancer by as much as 80 per cent in the screened
population.
Women have a choice of over 4,700 smeartakers in
almost 1,450 locations. Results are available quickly,
with reduced waiting times for colposcopy.
No screening test is 100 per cent accurate. The
value of a population-based screening programme,
such as CervicalCheck, is in the repeat nature of
screening.
Health professionals including registered GPs,
practice nurses and medical practitioners working
in primary care and in colposcopy services play a
vital role in providing an effective, quality assured
environment and experience in all stages of the
screening pathway.
It is important to also acknowledge the role that
every member of staff and management involved
in running the programme has played during the
first five years of CervicalCheck.
Through the combined effort of those working
on behalf of the programme, eligible women
and the wider community, cervical screening at
recommended intervals is becoming routine health
behaviour.
Majella Byrne
Head, National Screening Service
Dr Gráinne Flannelly
Clinical Director, CervicalCheck
1 Cancer in Ireland 2013: Annual Report of the National Cancer Registry; National Cancer Registry Ireland
2 CIN2+ and adenocarcinoma in situ included
THE NATIONAL SCREENING SERVICE
4
In the first five years
of CervicalCheck,
more than 1.65 million
smear tests provided
Updates
Completion of the first five years of CervicalCheck
CervicalCheck continues to innovate, with recent
initiatives including:
CervicalCheck completed its first five-year
screening round on 31 August 2013, with over
74 per cent of women age 25-60 having at least
one smear test. Over 1.65 million smear tests
were provided during the first five years with
more than 875,000 eligible women aged 25 to 60
having at least one CervicalCheck smear test.
• Facilitated referrals to colposcopy
CervicalCheck has transformed the experience
of cervical screening for eligible women, striving
to make the programme accessible and as easy
as possible for a woman to incorporate a regular
smear test into her routine health behaviour.
CervicalCheck uses a multi-layered approach,
communicating directly with health professionals
and community groups, using media and
other communication channels to promote
understanding of the value of regular smear tests
among its target population.
The programme itself is complex, involving all
aspects of delivery from register management,
administration, smeartaking in primary care,
cytology, colposcopy (diagnosis and treatment) and
histology services. Every aspect of the programme
is governed by quality assurance standards, based
on best international evidence and reviewed by a
panel of international experts before publication.
The second edition of these guidelines, published
in early 2014, builds on the learning of the past five
years of the programme and completion of the first
round of screening.
• A more accessible and user-friendly website
• Ability to analyse and evaluate additional
performance measures
• Introduction of HPV testing post colposcopy
• Tailored management plans at colposcopy
The programme is adapting within a changing
health environment, embracing developments
within HPV technology, and making preparations
for the inclusion of HPV vaccinated women in
the coming years. This discussion is similarly
reflected across other countries with a vaccination
programme.
Primary care
Women have a great degree of flexibility and a
broad choice of locations for their smear test. The
vast majority of women chose to have their smear
test carried out in a primary care setting. Primary
care settings include GP practices, Women’s Health,
Family Planning and Well Women Clinics.
The remainder of women had their CervicalCheck
smear test in a colposcopy clinic, public
gynaecology service or STI / GUM (sexually
transmitted infection / genito-urinary medicine)
clinic.
During the fourth year of the CervicalCheck
programme (1 September 2011 to 31 August
2012) over 90 per cent of women had their
smear tests in a primary care setting, which
is unsurprising with over 4,700 smeartakers
registered with CervicalCheck across
approximately 1,450 primary care settings.
UPDATES
6
CervicalCheck national study day
Best Education Project (General Practice/Pharmacy Section) at the Irish Health Care Awards 2012
Smeartaker supports and training
A dedicated Screening Training Unit co-ordinates
smeartaker education and training initiatives for
those starting out in practice, and clinical updates
for experienced smeartakers. The unit provides
comprehensive training and resources, developed
in collaboration with smeartakers, to ensure
provision in a flexible and meaningful way.
CervicalCheck won Best Education Project (General
Practice/Pharmacy section) at the Irish Health
Care Awards 2012. CervicalCheck also hosted a
successful national study day featuring national
and international speakers in Autumn 2012. The
study day provided a forum for discussing the
achievements of the programme as well as the
future of cervical screening.
Accredited smeartaker training modules are
provided through successful partnerships with
the Irish College of General Practitioners (ICGP),
Royal College of Surgeons in Ireland (RCSI) and the
National University of Ireland, Galway (NUIG).
There has been high level of engagement with
GP Training Schemes and a tailored training
programme was delivered to 316 GP trainees
during 2013. Accredited clinical update sessions
have been delivered to Irish Practice Nurse
Association (IPNA) practice nurses at regional
branch level. Continuing medical education (CME)
sessions were provided to clinically responsible
doctors. Over 98 per cent of smear tests were reported
as satisfactory during the period of this report,
reflecting the skill and professionalism of
smeartakers registered with the programme.
An eLearning portal provides a virtual learning
environment, facilitating busy health professionals
to advance their knowledge and skills in an
accessible, flexible format.
The eLearning portal includes CPD accredited
‘eUpdates’, a cervix image library, resources for GP
trainees, and educational modules on other NCSS
programmes (available at www.cervicalcheck.ie –
health professionals section).
Additional educational resources include the
recently revised ‘Desktop Guide for Smeartakers’.
7
UPDATES
Promoting regular smear test as a
routine health behaviour
A central principle of the programme is the need
for effective communication with eligible women,
particularly around raising awareness and driving
understanding of the importance of regular smear
tests for cervical health. The programme aims to
inform, educate and encourage eligible women to
participate in the CervicalCheck programme.
Maintaining high levels of screening over
time is a key challenge internationally for
population screening programmes. As the
target audience changes, with new women
entering the programme and awareness of the
programme growing across the wider population,
CervicalCheck works to ensure eligible women are
aware of the importance of regular smear tests as a
routine health behaviour, understanding the value
for their health across their lifetime.
Some women in more vulnerable situations can
face a number of barriers to participation and are
identified as harder-to-reach. Cutting through
the impediments to deliver a complex message
about the importance of regular smear tests is
best achieved using a comprehensive, sensitive
screening promotion approach.
UPDATES
A multi-layered approach is devised in partnership
by the Screening Promotion and Communications
team, which uses traditional mediums such
as advertising and public relations alongside
specific initiatives to encourage eligible women,
particularly those who are harder-to-reach. The Smeartaker Training Unit likewise has a key
role in reinforcing similar messaging amongst
the service providers. In addition, CervicalCheck
provides:
• A screening promotion team who work on
a national basis to increase awareness and
understanding.
• A Freephone information and support line.
• Leaflets designed in line with the National Adult
Literacy Agency (NALA) Plain English mark.
• An access offer who works to provide equal
access to screening for all women, including
those with disabilities.
• Resources designed to meet particular needs,
such as Braille, audio and different languages.
8
Cytology services
During 2013 a targeted campaign addressed two
key issues:
• Encouraging women aged 50-60 to participate.
The international trend for lower participation by
women towards the upper end of the age range
is reflected in Ireland and a concerted effort was
made to raise awareness of the importance of
participation across the age range.
• Targeting populations with a low uptake to
encourage women across the age range living in
those areas to participate.
Cytology services are provided for CervicalCheck
by Quest Diagnostics Inc and MedLab Pathology
Ltd, two laboratories contracted by the National
Screening Service (NSS) following a public
procurement process.
A National Cytopathology Training Centre located
at the Coombe Cytology Dept began processing
CervicalCheck samples from early 2013.
Performance is audited against standards set
for cytology as part of the programme to best
ensure turn-around times and other performance
indicators.
The National Screening Service is currently
engaged on a project with Healthlink and the
cytology laboratories to provide GPs registered
with Healthlink access to electronic cytology
results. The project is aiming for completion in
2014.
In order to avoid unnecessary smear tests for
women, follow-up of women with low grade
abnormalities was modified in April 2012.
Dr Gráinne Flannelly promoting the pearl of
wisdom, emblem of European Cervical Cancer
Prevention Week, January 2014
During the fourth year of the CervicalCheck
programme (1 September 2011 to 31 August
2012)
•Over 87 per cent of satisfactory smear tests
were found to be negative or normal.
•11 per cent showed low grade abnormalities.
•High grade abnormalities were detected in
1.6 per cent of smear tests.
9
UPDATES
Colposcopy services provided at
Letterkenny General Hospital
Sligo General Hospital
Mayo General Hospital, Castlebar
Louth County Hospital, Dundalk
Rotunda Hospital,
Dublin
Coombe Women and Infants
University Hospital, Dublin
University College Hospital, Galway
National Maternity
Hospital, Dublin
The Adelaide and Meath Hospital, incorporating
the National Children’s Hospital, Tallaght
Limerick Regional Maternity Hospital
South Tipperary General Hospital, Clonmel
Kerry General Hospital, Tralee
Wexford General Hospital
Waterford Regional Hospital
St Finbarr’s Hospital, Cork
UPDATES
10
Colposcopy services
Colposcopy services provided across fifteen
locations are vital to ensuring accurate diagnosis
and effective treatment of women who have had
abnormalities detected in their smear test.
CervicalCheck has greatly improved colposcopy
services in Ireland, increasing capacity and ensuring
services receive adequate investment and support.
In September 2013 a Colposcopy forum was hosted
by the NSS where colleagues from colposcopy
services nationally attended to discuss the
programme’s achievements, new developments
and quality assurance at colposcopy services. document describes the use of HPV testing for the
follow-up of treated women. It also updates clinical
advice on management and surveillance following
colposcopy. Where appropriate a combined smear
and HPV test will be provided a year following
treatment.
Updated clinical guidance on the management of
low grade abnormalities was introduced in early
2014. This tailored approach will identify at an
earlier stage those women who need treatment.
A number of IT changes and information sources
were introduced in order to
facilitate this. Women who attend
an initial colposcopy where no
CIN is identified will be placed
under surveillance and receive a
combined smear and HPV test
in a year’s time.
Performance is monitored
against standards set for
colposcopy as part of the
programme and information
gathered centrally is analysed
to produce the results in this
report. Colposcopy services
are provided by clinicians
certified by the British
Society for Colposcopy
and Cervical Pathology
(BSCCP).
CervicalCheck commits to offering colposcopy
appointments:
Participants at recent colposcopy forum hosted
at King’s Inns House
CervicalCheck continually works to better identify
those women who need treatment and further
surveillance. Progress has been made in this area
with revised NSS ‘Guidelines for Quality Assurance
in Cervical Screening’ issued recently by the
Quality Assurance committee. A clinical guidance
11
• Urgent referrals within two weeks of smear test
results
• High grade cell changes within four weeks of
smear test results
• Low grade cell changes within eight weeks of
smear test results.
UPDATES
The programme continues to work towards
achieving and surpassing standards to avoid
anxiety and maximise efficiency in diagnosis and treatment for the woman.
During the fourth year of the CervicalCheck
programme (1 September 2011 to 31 August
2012) the programme exceeded the standard
set at 90 per cent for urgent and low grade
referrals, with over 93 per cent of women
being offered an appointment within eight
weeks of the date the letter was received in
the clinic.
Facilitated referral process for
colposcopy services
The facilitated referral process, recommending a
specific colposcopy service for a woman requiring
referral, has been of benefit both in terms of
capacity management and ensuring appointments
are given within programme targets. This ensures
that women are referred to colposcopy services
with available capacity within agreed targets for
offering an appointment.
The facilitated referral process has also seen
particular benefit in temporarily diverting
referrals from a colposcopy service that becomes
unavailable due to unforeseen circumstances.
During flooding at Letterkenny General Hospital
in August 2013, referrals were quickly diverted to
Sligo General Hospital until the hospital reinstated
its service areas. This minimised disturbance to
women and ensured referrals occurred in a timely fashion.
UPDATES
Histopathology services
Biopsy samples taken at colposcopy are analysed
in histopathology laboratories to determine the
degree of abnormality found. Treatment decisions
are based on histopathology outcomes.
In 2013 NSS extended the scope of its agreements
with hospitals providing colposcopy to include
histopathology.
Positive predictive value for
CervicalCheck programme smear tests
One of the most important quality measures for
a screening programme is the positive predictive
value (PPV) as it reflects the probability that a
positive test has detected the underlying condition
being tested.
The positive predictive value is a measure of the
likelihood that a woman with a positive smear test
actually has a pre-cancerous cervical abnormality
or a cancer diagnosis.
Cervical screening programmes aim for early
detection of high grade abnormalities while
minimising unnecessary investigations, anxiety
and possible overtreatment. The value of cytology
as a test takes into account both the sensitivity
(ability to detect a problem and avoidance of
false negatives) and specificity (avoidance of false
positives).
During the fourth year of the CervicalCheck
programme (1 September 2011 to 31 August
2012) the positive predictive value of
Colposcopic impression was 75.3 per cent,
above the programme standard of 65 per cent.
12
328,000+
women screened from September 2011 August 2012
Programme statistics
Introduction to the statistics 2011/2012
CervicalCheck became a national screening programme on 1 September 2008. The figures reported in
this section relate to the fourth year of operation (1 September 2011 to 31 August 2012). During this
period the programme operated both an invitation entry system whereby eligible women received an
invitation letter to screening and ‘direct entry’ whereby a woman could be screened by a smeartaker who
could check her eligibility using an on-line facility.
The response to the programme has been very positive with 328,161 women attending for screening during
the reporting period. Quality assurance underpins every aspect of the CervicalCheck programme. The
programme’s performance is measured against Key Performance Indicators (KPIs) as outlined in Guidelines
for Quality Assurance in Cervical Screening First Edition 2009.
Table 1 shows the number of women screened by age group. Women between the ages of 25 and 60 are
invited to screening, but a small number of women under 25 may attend under specific criteria. Those
women aged 61 or over may have presented for the first time at this age and so were eligible for a first smear
test, may have received their invitation to screening at age 60 but delayed some time before presenting for
screening, or may reflect women having follow-up smear tests performed.
Table 1: Number of women screened by age group
Age group
<25* Number of women screened
%
1,812 0.6 25 - 29 55,083 16.8 30 - 34 60,128 18.3 35 - 39 54,378 16.6 40 - 44 47,254 14.4 45 - 49 38,936 11.9 50 - 54 30,840 9.4 55 - 59 23,599 7.2 60 3,659 1.1 ≥61 12,472 3.8 Total: 328,161 100
* Based on evidence to date, there is no additional public health benefit in starting population screening below the age of 25.
Screening in women under the age of 25 may lead to many women receiving unnecessary treatment for lesions that would
never have developed into invasive cancer. Certain exemptions apply where some women over the age of 60 and under the
age of 25 are considered eligible. Such exemptions may include women of any age who are post colposcopy, women over the
age of 60 who have never had a smear test and women aged 20 and over who are on renal dialysis, have HIV infection, are post
organ transplant or who have had a previous abnormal smear test result and are within the recommended follow-up period.
PROGRAMME STATISTICS
14
Programme coverage
Coverage is defined as the proportion of unique women who have had at least one satisfactory smear test
taken within the defined period, expressed as a percentage of the total number of eligible women in the
population. It is a measure of how well the programme is reaching the target population.
The overall percentage of the eligible population screened in the first four years of the national programme
was 67.9 per cent nationwide. This demonstrates that CervicalCheck continues to improve coverage,
following successful achievement of its target coverage during the first screening round (in years one to three
of the national programme coverage was 60.9 per cent).
The geographical spread of screening coverage based on the eligible population of each county is shown in
Figures 1 and 2.
Figure 1: Percentage of eligible women screened based on county of residence* from 1 September 2008 to 31 August 2012
100%
80%
70%
60%
50%
40%
30%
Wicklow
Wexford
Westmeath
Waterford
Tipperary
Sligo
Roscommon
Offaly
Monaghan
Meath
Mayo
Louth
Longford
Limerick
Leitrim
Laois
Kilkenny
Kildare
Kerry
Galway
Dublin
Donegal
Cork
Clare
0%
Cavan
10%
Carlow
20%
* Population based on CSO 2011 Census extrapolated to 2012
15
PROGRAMME STATISTICS
Figure 2: Map showing percentage of eligible women screened by county of residence* from 1 September 2008 to 31 August 2012
Eligible Women Screened
September 2008 – August 2012
Coverage
> =70%
65%-69%
<65%
70km
40mls
* Data analysed using Health Atlas Ireland.
Population based on CSO 2011 Census extrapolated to 2012
PROGRAMME STATISTICS
16
Coverage of the programme by age range for the first four years is shown in Figure 3. These figures represent
the number of women screened compared to eligible women as outlined in Census 2011 extrapolated to
2012.
A consistent pattern has been evident since the inception of the programme, with the highest coverage seen
in younger age groups and coverage gradually decreasing with increasing age.
Figure 3: Coverage of women by age group
100%
80%
70%
% coverage
60%
50%
40%
30%
20%
10%
0%
25-29
30-34
35-39
40-44
45-49
Age group
50-54
55-59
60
Most women (90.8 per cent) had their smear tests carried out in a primary care setting; 93.2 per cent of
these attended a GP practice. For the remainder of women, the first CervicalCheck smear test occurred in a
colposcopy clinic, public gynaecology service or STI/GUM clinic.
17
PROGRAMME STATISTICS
Laboratory turnaround time
One of the criteria for the selection of laboratories for the provision of cytology services was the capacity and
ability to process smear tests within 10 days to facilitate the provision of results to women within four weeks
from the date of the smear test. Table 2 shows how the laboratories performed over the fourth year of the
programme. Overall for the reporting period 88.2 per cent of test results were received by the programme
within two weeks, slightly below the target set.
The laboratories’ performance metrics are audited and monitored on an ongoing basis to ensure adherence
to the guidelines for quality assurance in cervical screening.
Table 2:
Laboratory turnaround time - time from receipt of sample at laboratory to results
returned to the programme
Performance parameter
% results returned within two weeks of receipt of sample at laboratory.
2011/12
Target
88.2%
>90%
CervicalCheck women’s charter
The CervicalCheck women’s charter includes the commitment that “your result and any treatment
recommendation will be provided to you and your nominated smeartaker by the programme within four
weeks”. Laboratories typically provide written results to doctors within three weeks of receipt of samples.
The programme is notified that the result is available, and women are issued a letter from the programme
outlining the next step and any recommendation following their smear test.
By the end of August 2012 almost 75 per cent of women received a results letter from the programme within
four weeks (over 91 per cent within five weeks) of their smear test date (Table 3 & Figure 4). Over the first four
years of the national programme there has been sustained improvement. The number of women sent results
letters within four weeks increased from 40.5 per cent in 2008-2009 to 74.8 per cent in 2011-2012. Ongoing
monitoring and actions are taken to progressively improve this response time, working with smeartakers on
sample submission as well as process improvements.
Table 3: Percentage of women sent results letter within four weeks of smear test date
Time from smear test to results letter printed date
Within 4 weeks PROGRAMME STATISTICS
2011/12
Target
74.8%
>90%
18
Figure 4: Time in weeks for results letter sent to women (%)
4.4%
3.6%
17.1%
Up to 4 weeks
4-5 weeks
5-6 weeks
Over 6 weeks
74.9%
Cytology
Cytology findings reported in Tables 4 and 5 are based on smear test results received by the programme in
the period 1 September 2011 to 31 August 2012, rather than the smear test date. Of the 364,213 smear tests
taken, a small number were unsatisfactory (Table 4). The outcomes of the remaining 359,659 satisfactory
smears are reported in Table 5.
Table 4:
Cytology findings for smear test results
Smear tests
Cytology findings
Total number of smear
tests processed Unsatisfactory/ inadequate smear test Satisfactory/
adequate smear test
N
N
%
N
%
364,213
4,554
1.3
359,659
98.7
19
PROGRAMME STATISTICS
Over 87 per cent of satisfactory smear test results in the period were found to be negative or normal. Of the
remainder, 11 per cent showed low grade abnormalities and 1.6 per cent showed high grade abnormalities
(HSIL (moderate or severe), ASC-H, query invasive squamous carcinoma or query glandular neoplasia).
The high rate of low grade abnormalities remained an interesting feature of the programme during this year.
This is because some were repeat smears that were recommended following a previous low grade smear test result.
Table 5:
Cytology results excluding unsatisfactory smear tests
Cytology results NAD (no abnormality detected)
Low Grade
ASCUS AGC (Atypical Glandular Cells)
LSIL
High Grade
N
%
314,476
87.4
25,497
7.1
1,211
0.3
12,860
3.6
ASC-H 2,026
0.6
HSIL (Moderate)
1,683
0.5
HSIL (Severe)
1,870
0.5
Query Squamous Cell Carcinoma
10
0.0
Query Glandular Neoplasia or AIS
26
0.0
359,659
100
Total
Of smear tests performed outside of colposcopy clinics 14,194 (4.2%) resulted in a referral to colposcopy. PROGRAMME STATISTICS
20
Diagnosis and treatment
The provision of high quality colposcopy services with timely diagnosis and treatment is a crucial component
of successful cervical screening programmes and remains a key priority for the CervicalCheck programme.
Fifteen colposcopy services nationwide work with the Programme, each with agreed individualised service
plans delivered by dedicated multidisciplinary teams. Information is collected electronically and a central
data extraction performed. These data form the basis for this section of the report.
Table 6:
Outcome of appointments at colposcopy clinics
First visits
Follow-ups
Total
N% N% N%
Attended
16,621
72.6
43,202
53.7
59,823
57.9
Cancelled
5,056
22.1
28,609
35.6
33,665
32.6
Did not attend (DNA)
1,172
5.1
8,531
10.6
9,703
9.4
54
0.2
60
0.1
114
0.2
22,903
100
80,402
100
103,305
100
Not recorded
Total
During the year 16,621 women attended colposcopy for the first time. This represents a slight drop on the
previous year. The sustained increase in referrals seen in previous years is reflected in a doubling of the
numbers of women attending for follow up appointments (43,202 in 2012 compared to 20,769 in 2011). It is important to note the number of women referred and the number of new referrals attended will not be
the same in any given time period. This is because of the lead time between the colposcopy referral and the
date of the first colposcopy visit as well as additional referrals for clinical reasons.
Figure 5: Attendance at colposcopy services from 1 September 2008 – 31 August 2012
Sep 2011 – Aug 2012
Sep 2010 – Aug 2011
Sep 2009 – Aug 2010
Sep 2008 – Aug 2009
0
5,000
10,000
Number of first visits
21
15,000
20,000
25,000
30,000
35,000
40,000
45,000
50,000
Number of follow-up visits
PROGRAMME STATISTICS
Of the 16,621 new attendances at colposcopy, information on the age of the woman was available for 16,488
(99.2%). The mean age at referral was 36 years. The majority of women were aged between 25-45 years with
3.8 per cent aged under 25 years and 11.3 per cent over 50 years.
According to the standards for colposcopy for the CervicalCheck programme the rate of defaulted
appointments where no prior notice was given (DNA) should be kept to a minimum and maintained below
15 per cent.
Women who default from attendance at colposcopy services according to CervicalCheck
standards
Performance parameter
2011/12
Target
9.4%
<15%
The percentage of women who do not attend and who do not notify the clinic should be maintained at a low level to maximise the efficiency of the clinic and to avoid the loss of women to follow-up. The rate of DNA appointments is presented according to the type of visit and the age of the woman (Table
7). The DNA rate is higher for return visits than for first visits. As reflected in last year’s report, younger
women were more likely to default than older women. This may reflect higher levels of mobility within this
population of women.
Table 7: DNA rates for appointments offered to women by age group
Age in years at
first offered appointments
Number of first
appointments
First
visit DNA
rate (%)
Number of
follow-up
appointments
Follow-up
visit DNA
rate (%)
946
12.6
5,798
15.5
25 – 29
6,224
5.5
23,412
12.0
30 – 34
5,011
5.5
17,952
11.2
35 – 39
3,420
5.1
11,470
9.7
40 – 44 2,596
4.0
8,381
8.5
45 – 49
1,927
2.9
5,897
7.5
50 – 54
1,310
2.7
3,592
6.7
55 – 59
684
3.1
1,893
6.1
60 77
2.6
248
3.6
≥61
355
1.7
654
5.2
Not recorded
353
9.3
1,105
12.8
<25
PROGRAMME STATISTICS
22
Reasons for referral
Of the 16,621 new referrals who attended colposcopy services, consent information was available for the
CervicalCheck programme for 16,590 women (99 per cent). For the remaining one per cent the consent
information was not recorded. The reasons for referral to colposcopy for these women were:
• 83 per cent were referred on the basis of an abnormal smear
• 17 per cent for clinical reasons
A number of women were referred to colposcopy from outside of the programme for clinical reasons such
as an abnormal smear test result or for clinical reasons such as symptoms of abnormal vaginal bleeding or a
suspicion of an anatomical abnormality of the cervix (Table 8).
The relative increase in clinical referrals is facilitated by an increase in capacity for these referrals at
colposcopy which previously would have been seen in outpatient gynaecology services (Figure 6).
Table 8: Reason for referral to colposcopy
New referrals for whom consent is available
Reason for referral to colposcopy N
%
13,728
82.8
Clinical indication – non urgent
1,531
9.2
Clinical indication – urgent
1,316
7.9
16,575
100
Abnormal smear test result
Total*
* 15 women had no reason entered
Figure 6: Reason for referral for women attending colposcopy services from 1 September 2008 – 31 August 2012
6,000
5,000
Number
4,000
3,000
2,000
1,000
0
Sep 2008–
Feb 2009
Low grade
23
Mar 2009 –
Aug 2009
Sep 2009 –
Feb 2010
High grade
Mar 2010 –
Aug 2010
Sep 2010 –
Feb 2011
Clinical indication – non urgent
Mar 2011 –
Aug 2011
Sep 2011 –
Feb 2012
Mar 2012 –
Aug 2012
Clinical indication – urgent
PROGRAMME STATISTICS
Of the 13,728 women who presented with an abnormal smear, 4,092 (30%) were referred following detection
of a high-grade abnormality (Table 9). The detection of a low-grade smear test result (LSIL or ASCUS) was the
reason for referral in 8,690 (63%) women and a smear test showing AGC (borderline glandular cells) was the
reason for referral in 883 cases (6.4%). The numbers of women referred with persistently unsatisfactory or
inadequate results (63; 0.5%) remained consistently low.
Table 9: Reason for referral to colposcopy as a result of an abnormal smear test result
Referral smear abnormality Unsatisfactory / inadequate
Low Grade
ASCUS
AGC (borderline glandular)
LSIL
High Grade
New referrals for whom consent is available
N
%
63
0.5
4,334
31.6
883
6.4
4,356
31.7
ASC-H
1,410
10.3
HSIL (moderate)
1,272
9.3
HSIL (severe)
1,377
10.0
Query invasive squamous carcinoma
11
0.01
Query glandular neoplasia AIS / adenocarcinoma
22
0.2
13,728
100
Total
PROGRAMME STATISTICS
24
Waiting times
One of the key challenges faced by the CervicalCheck programme in the first four years was the provision of
access to colposcopy in a timely fashion for women. Since the start of the programme, services have been
actively engaged in a process to increase capacity and this has resulted in sustained improvements year on
year.
Standards for the programme state that 90 per cent of women with high grade cytological abnormalities
should wait less than four weeks and 90 per cent of all women should wait less than eight weeks for an
appointment.
For the period 1 September 2011 to 31 August 2012 information on waiting times was available for 15,115 of
the 16,590 new attendances (Table 10, Figure 7).
For women referred to colposcopy with a smear test suggestive of CIN2/CIN3, 81.6 per cent were seen within
four weeks.
Overall however, only seven per cent of women experienced waiting times of longer than eight weeks and in
only one per cent of cases the wait was longer than 12 weeks. This represents a considerable improvement
in the fourth year of the programme (during the previous year the wait was longer than 12 weeks in 15.8 per
cent of cases).
Figure 7: Waiting time for colposcopy services over first four years of the programme – measured
against CervicalCheck standards over time
100%
80%
60%
40%
20%
0%
Sep 2008–
Aug 2009
All women referred to
colposcopy should be
offered an appointment
within eight weeks of
the date the letter was
received in the clinic
25
Sep 2009 –
Aug 2010
All women referred to
colposcopy with a smear
suggestive of CIN 2 or CIN
3 should be offered an
appointment within four
weeks of the date the letter
was received in the clinic
Sep 2010 –
Aug 2011
All women referred
to colposcopy with a
suspicion of invasive
cancer on a smear should
be offered an appointment
within two weeks of
the date the letter was
received in the clinic
Sep 2011 –
Aug 2012
All women referred to
colposcopy with a smear
suggestive of glandular
neoplasia should be
offered an appointment
within four weeks of
the date the letter was
received in the clinic
PROGRAMME STATISTICS
Waiting times for colposcopy measured against colposcopy standards
Performance parameter
2011/12
Target
All women referred to colposcopy should be offered an appointment within eight weeks of date the letter was received in the clinic.
93.4% > 90%
All women referred to colposcopy with a smear suggestive of CIN 2 or CIN 3 should be offered an appointment within four weeks of date the letter was received in the clinic.
81.6% > 90%
All women referred to colposcopy with a suspicion of invasive cancer on a smear should be offered an appointment within two weeks of date the letter was received in the clinic.
100% > 90%
All women referred to colposcopy with a smear suggestive of glandular neoplasia should be offered an appointment within four weeks of the date the letter was received in the clinic
95.5% > 90%
Table 10: Waiting times for women referred to colposcopy grouped by grade of referral smear test
High grade
Low grade
Total
N% N% N%
Less than 2 weeks
1,411
35.1
1,639
17.4
3,050
22.7
Between 2 and 4 weeks
1,848
45.9
2,274
24.1
4,122
30.6
Between 4 and 8 weeks
689
17.1
4,695
49.7
5,384
40.0
Between 8 and 12 weeks
42
1.0
703
7.4
745
5.5
Greater than 12 weeks
12
0.3
129
1.4
141
1.0
PROGRAMME STATISTICS
26
Biopsy rates measured against colposcopy standards
Performance parameter
2011/12
Target
A biopsy should be performed in the presence of an atypical Transformation Zone and a smear test which suggests underlying CIN.
88.0%
>95%
If there is a suspicion of invasive disease a biopsy must be performed immediately.
93.9% >90%
The role of colposcopy is to facilitate diagnosis and treatment of women with abnormal smear test results.
Where an abnormality is suspected at colposcopy it is good practice to perform a biopsy to confirm the
diagnosis. There are two main types of biopsy performed – a diagnostic biopsy, which involves sampling a
portion of the abnormal area only, and an excisional biopsy which removes the abnormal area in its entirety.
During the reporting period 13,373 diagnostic biopsies, 7,375 excisional biopsies and 40 other biopsies were
performed. The initial colposcopy visit determines the presence or absence of an atypical Transformation
Zone. A biopsy was performed in 88 per cent of cases where the transformation zone was documented as
atypical and over 93 per cent of cases where an invasive cancer was suspected.
Figure 8: Number of women undergoing biopsy at colposcopy services
12,000
10,000
Number
8,000
6,000
4,000
2,000
0
Sep 2008–
Feb 2009
Mar 2009 –
Aug 2009
Sep 2009 –
Feb 2010
Mar 2010 –
Aug 2010
All appointments
27
Sep 2010 –
Feb 2011
Mar 2011 –
Aug 2011
Sep 2011 –
Feb 2012
Mar 2012 –
Aug 2012
First appointments
PROGRAMME STATISTICS
The biopsy rates according to the grade of the referral smear test and reasons for referral are presented in
Table 11. Eighty five per cent of women presenting with a high grade cytological abnormality had a biopsy
performed at the first visit compared with 60 per cent of women presenting with a low grade cytological
abnormality. Over 69 per cent of women presenting with AGC (borderline glandular cells) had a biopsy
at the first visit which included an excisional biopsy in 16.4 per cent. This reflects the continued difficulty
of managing this relatively new group of women particularly if the colposcopic appearance is normal or
unsatisfactory.
Table 11: Biopsies performed during the first visit to colposcopy according to referral smear grade
Biopsy performed
Excisional Diagnostic
No biopsy Total biopsybiopsy taken
Grade of cytology result of referral smear
N
%
N
%
N
%
N
%
AGC (borderline glandular)
145
16.4
468
53.0
270
30.6
883
100
High Grade
1,193
29.2
2,283
55.8
616
15.1
4,092
100
Low Grade
360
4.1
4,821
55.5
3,509
40.4
8,690
100
2
3.2
19
30.2
42
66.7
63
100
1,700
12.4
7,591
55.3
4,437
32.3
13,728
100
Unsatisfactory / inadequate
Total
PROGRAMME STATISTICS
28
Treatment at colposcopy
Effective treatment of high grade CIN and adenocarcinoma in situ with subsequent reduction of the risk
of invasive cancer is vital to the success of any cervical screening programme. This treatment should be
effective, safe and acceptable. It should aim to eradicate all CIN from the cervix and should be tailored to the
circumstances of the individual woman.
The standards for the CervicalCheck programme state that treatments be performed as an outpatient
procedure under local anaesthetic more than 80 per cent of the time. During the fourth year of the
programme treatment was performed as an outpatient using local anaesthetic 94 per cent of the time,
surpassing this target.
The outcome of use of local anaesthetic measured against colposcopy standards
Performance parameter
The majority of women should have treatment performed as an outpatient under local anaesthetic.
2011/12
Target
94.0
>80%
During the reporting period, 8,109 treatments were recorded at colposcopy. Large loop excision of the
Transformation Zone (LLETZ) was performed in 7,236 (89.2%) and ablative treatment was used in 758 (9.3%)
cases. Forty cone biopsies (0.5%), 74 hysterectomies (0.9%) and one trachalectomy (0.01%) were performed
(Figures 9 and 10). Of the total treatments, 7,545 were performed following an abnormal smear test.
Figure 9: Treatment at colposcopy
0.9%
0.01%
9.3%
0.5%
Ablation
Cone Biopsy
LLETZ
Hysterectomy
Trachalectomy
89.2%
29
PROGRAMME STATISTICS
Figure 10: Number of women undergoing treatment at colposcopy
4,500
4,000
3,500
Number
3,000
2,500
2,000
1,500
1,000
500
0
Sep 2008–
Feb 2009
Mar 2009 –
Aug 2009
Sep 2009 –
Feb 2010
Mar 2010 –
Aug 2010
All appointments
Sep 2010 –
Feb 2011
Mar 2011 –
Aug 2011
Sep 2011 –
Feb 2012
Mar 2012 –
Aug 2012
First appointments
Table 12: Treatment at first visit to colposcopy
Reason for referral
to colposcopy
No treatment
on first visit
Treatment on
first visit
Total number of
women attended
N% N% N%
Clinical indication
– non urgent
1,472
96.1
59
3.9
1,531
100
Clinical indication – urgent
1,282
97.4
34
2.6
1,316
100
737
83.5
146
16.5
883
100
High grade
2,901
70.9
1,191
29.1
4,092
100
Low grade
8,330
95.9
360
4.1
8,690
100
61
96.8
2
3.2
63
100
14,783
89.2
1,792
10.8
16,575
100
AGC
(borderline glandular)
Unsatisfactory
/inadequate
Total
PROGRAMME STATISTICS
30
One of the key challenges of screening is the avoidance of overtreatment. This is of particular relevance to
cervical screening because treatment has the potential to have an adverse effect on future fertility. In this
regard treatment at the first visit for women who present with low grade abnormalities should be avoided
and kept below 10 per cent. During the fourth year of the programme this figure was within the target at 4.1
per cent.
It is generally accepted that most of the women who undergo excisional procedures should have CIN on
histology on the excised specimen. This is particularly true if the procedure is performed at the first visit to
colposcopy. During the fourth year of the CervicalCheck programme this target was reached with nearly 92 per cent of women treated at the first visit having CIN on histology.
The performance of colposcopy treatment parameters measured against colposcopy standards
Performance parameter
2011/12
Target
4.1%
<10%
Women treated by excisional treatments at first visit should have CIN on histology. 91.8%
>90%
Women treated by excisional treatments at any visit should have CIN on histology.
91.0%
>80%
Treatment at first visit should not be performed on women who present with low grade cytological change even if there is a Colposcopic suspicion of high grade disease (except in special circumstances).
Colposcopy plays an important role in the evaluation of women with suspected cervical abnormalities. It
allows the identification of the site of the abnormality as well as an estimation of the grade of abnormality
including the presence or absence of features suggestive of invasive cancer. The correlation between the
colposcopic impression and histological diagnosis is a useful marker of the quality of colposcopy. During the
year the positive predictive value of a colposcopic impression of high grade disease was 75 per cent which
exceeds the CervicalCheck standard (>65%).
The positive predictive value of colposcopy measured against colposcopy standards
Performance parameter
Compliance between Colposcopic impression of high grade disease and histologically proven high grade CIN.
31
2011/12
Target
75.3%
>65%
PROGRAMME STATISTICS
Histology
The objective of a cervical screening programme is the detection and treatment of high grade CIN and the
yield of these abnormalities is one of the hallmarks of a successful programme. The histology is presented
by year in Figure 11. The yield of high grade abnormalities remained consistently high and illustrates
the programme is achieving its objective of detection and treatment of high grade CIN. This reflects the
sustained high levels of activity in the colposcopy services. Figure 11: Detection of CIN and cancer
7,000
6,000
5,000
Number
4,000
3,000
2,000
1,000
0
Sep 2008-Aug 2009
No CIN
Sep 2009-Aug 2010
Sep 2010-Aug 2011
Low grade CIN
High grade CIN
Performance parameter
Biopsy specimens should be suitable for histological diagnosis
PROGRAMME STATISTICS
Sep 2011-Aug 2012
Cancer
2011/12
Target
98.7%
>95%
32
33
PROGRAMME STATISTICS
654
144
211
1
6
11
LSIL
ASC-H
HSIL
(moderate or severe)
Query invasive
squamous carcinoma
Query glandular
neoplasia AIS / adenocarcinoma
Unsatisfactory /
Inadequate
1,999
249
AGC
(borderline glandular)
Total 723
ASCUS
14.5
40.7
20.7
10.0
6.0
9.7
15.0
29.2
20.9
1,224
5
1
0
147
103
435
85
448
8.9
18.5
3.4
0.0
4.2
7.0
10.0
10.0
12.9
4,243
8
3
0
501
324
1,732
244
1,431
30.8
29.6
10.3
0.0
14.2
21.9
39.7
28.6
41.3
2,363
0
1
0
560
272
925
88
517
17.2
0.0
3.4
0.0
15.9
18.4
21.2
10.3
14.9
3,688
3
9
1
2,007
610
603
124
331
26.8
11.1
31.0
10.0
56.9
41.2
13.8
14.5
9.6
123
0
5
1
29
12
14
52
10
0.9
0.0
17.2
10.0
0.8
0.8
0.3
6.1
0.3
115
0
4
7
71
16
1
12
4
0.8
0.0
13.8
70.0
2.0
1.1
0.02
1.4
0.1
Grade of cytology result of referral smear
N
%
N
%
N
%
N
%
N
%
N
%
N
%
No CIN/No HPV
HPV / Cervitis
CIN 1
CIN 2
CIN 3
Adenocarcinoma
Cancer
(normal)
only
in situ / CGIN
(including micro invasive)
Table 13: Histology results for women who had a satisfactory biopsy in colposcopy from 1 September 2011 to 31 August 2012
Performance measures for CervicalCheck programme smear tests
Cervical screening programmes have to balance the early detection of high grade abnormalities with
avoiding unnecessary investigations and possible overtreatment. Performance measures have been
developed which look at how valid the screening tests are within organised programmes. These include the
positive predictive value (PPV), abnormal predictive value (APV), total predictive value (TPV) and referral
value (RV). Measures of the performance of cytology
PPV
75.6%
APV
28.7%
TPV
45.8%
RV
2.18
The positive predictive value (PPV) is reported as the percentage of women referred with high-grade
cytological abnormality who have a histological diagnosis of CIN2 or higher. During the current reporting
year the PPV was 75.6 per cent.
The abnormal predictive value (APV) calculates the percentage of samples reported as borderline or lowgrade that led to referral to colposcopy and subsequent histological diagnosis of CIN2 or higher. During the
current reporting year the APV was 28.7 per cent.
The total predictive value (TPV) examines the percentage of all women referred to colposcopy on the basis
of an abnormal smear who have a histological outcome of CIN2 or worse. During the reporting year 45.8 per
cent of women referred to colposcopy had CIN2 or higher demonstrated on histology.
The referral value (RV) looks at this in another way and examines the number of women referred to
colposcopy for the detection of one case of CIN2 or worse. During the current reporting year, for every
2.18 women referred to colposcopy one had CIN2 or higher detected (for every 218 women referred to
colposcopy 100 had CIN2 or higher detected).
PROGRAMME STATISTICS
34
Glossary
Ablation
ASC-H
Cervical screening
Treatment which involves the
destruction of the cervical
abnormalities using a variety
of techniques. It does not allow
for histological examination of
the whole abnormal area and
strict criteria must be followed
therefore to minimise the risk of
inadvertent treatment of hidden
microinvasive cancer.
Atypical squamous cells for which
a high-grade lesion cannot be
excluded.
A process which involves the
application of a screening test
at regular intervals to a defined
population of women to detect
pre-cancerous changes.
ASC-US
Atypical squamous cells of
undetermined significance.
Cervical cytology
Atypical Transformation Zone
A microscopic examination of a
single layer of cells scraped from
the surface of the cervix.
A smear test which shows cells
which are not typically normal
or where pre-cancerous or
cancerous cells are identified.
The term used when changes
are detected by colposcopy in
the Transformation Zone. These
changes can include a variety of
patterns including: leukoplakia,
acetowhite epithelium and
abnormal vascular patterns.
Adenocarcinoma
Biopsy
Abnormal/not normal smear
test
A cancer affecting the cervix,
but involving the columnar
(endocervical) cells rather than
the squamous cells. The columnar
cells are involved in glandular
activity.
Adenocarcinoma in situ
A pre-cancer affecting the cervix,
but involving the columnar
(endocervical) cells rather than
the squamous cells.
Adequate smear test result
A smear test which is deemed
satisfactory for evaluation by the
laboratory.
AGC
Atypical glandular cells.
AGUS
Atypical glandular cells of
undetermined significance.
35
The removal of a sample of tissue
from the body for examination
using a microscope.
Cervical cancer
Cancer of the cervix. Cancer cells
have spread beyond the natural
basement membrane boundary
of the cervical skin. Cervical
cancer can be of squamous origin
(approximately 85%) or glandular
origin (approximately 15%).
Cervical intraepithelial
neoplasia (CIN)
CIN is not cancer but is the
histological term referring to the
abnormal growth of pre-cancerous
cells in the surface layers of the
cervix. It describes varying degrees
of abnormality of the cells within
and confined to the epithelium.
There are three grades of CIN: CIN 1, CIN 2 or CIN 3.
Colposcopy
An examination of the cervix
using a specialised optic
instrument (colposcope) that
provides magnification to allow
direct observation and study of
vaginal and cervical epithelium.
It identifies lesions on the cervix
which can be biopsied and
treated.
Cone biopsy
A surgical removal of a coneshaped section of the cervix to
remove abnormal cells.
Coverage
The proportion of women aged
25-60 years who have had a
screening result recorded on
the screening register over a
complete screening round.
Diagnosis
A process aimed at the
clarification of cervical
abnormalities to inform decisionmaking regarding treatment.
Dyskaryosis
Term used in cytology to describe
nuclear abnormalities in cervical
cells.
GLOSSARY
Eligible for screening
Informed consent
Lesions
Woman aged 25 to 60 who live in Ireland are eligible to have a
free smear test.
The giving of all the necessary
information by the smeartaker
to the woman in order that she
fully understands the smear
test procedure and possible
results so that she can make
an educated decision to
participate in the programme.
For the CervicalCheck informed
consent process, the necessary
information covers participation
in the programme, the transfer of
data to third parties, limitations of
screening, results, associated tests
and treatment.
A zone of tissue with impaired
function as a result of damage by
disease or wounding.
Excisional treatment
Treatment which involves the
removal of the abnormality in
its entirety thereby allowing
histological examination of the
entire Transformation Zone.
HSIL
High grade squamous
intraepithelial (moderate and
severe) lesion encompassing
moderate (CIN 2) and severe
dysplasia (CIN 3/CIS).
Histology
The microscopic study of the
structure and composition of
body tissue.
Human papillomavirus (HPV)
A group of wart viruses of which
a high proportion are sexually
transmitted. Over 100 different
types of HPV have been identified
and each is known by number.
Types 6 and 11 are associated
with genital warts and types 16
and 18 are associated with high
grade lesions.
Hysterectomy
The surgical removal of the uterus
(womb) – called total if it includes
the cervix or subtotal/partial if the
cervix is not entirely removed.
Incidence
The number of new cases of a
disease or happening that occurs
in a given period in a specified
population
GLOSSARY
Invasive cancer
Abnormal cells, not limited to
the outer layer of the epithelial
but which breach the basement
membrane to invade the
underlying stroma (layer of
tissue).
Key performance indicators
(KPIs)
A metric used to help an
organisation define and measure
progress toward organisational
goals or standards.
Large loop excision of the
Transformation Zone (LLETZ)
Large loop excision of the
Transformation Zone is a
diagnostic and/or treatment
method to remove the cervical
areas of abnormality. The
procedure involves removal of the
entire Transformation Zone using
a thin wire electrode charged
with electric current to provide
a sample for examination by the
pathologist.
Liquid based cytology (LBC)
The placement of harvested cells
into a special transport solution
for sending to the laboratory,
where the slide is made ready for
examination.
LSIL
Low grade squamous
intraepithelial lesion
encompassing HPV infection or
mild dysplasia (CIN 1).
Microinvasive cancer
This represents early stage
cervical cancer where the
abnormal cells breach the
basement membrane and invade
to not greater than 5mm in depth
and not more than 7mm in width.
Mortality
The number of deaths from
a specified disease during a
defined period of time in a given
population.
NAD
No abnormality detected
(normal).
Positive predictive value (PPV)
The proportion of test-positive
women who are truly positive. It
can be considered a measure of
the likelihood that a woman with
a positive test truly has a precancerous cervical abnormality.
36
Primary care setting
Squamous
First contact care that is not
hospital or specialist care general practice, Well Woman and
Family Planning Clinics.
A type of multi-layers cells, which
line the vagina and outer layer of
the cervix.
Quality assurance
A programme for the systematic
monitoring and evaluation of the
various aspects of the National
Cervical Screening Programme to
ensure that standards of quality
are being met.
Screening programme
An organised approach to
screening a defined population
to determine the likelihood of
a specific disease within the
population with the aim of
reducing the risk of the disease
and improving the quality of life
through early diagnosis.
Select and treat
A process whereby women with
suspected high grade disease are
selectively treated at the first visit
to colposcopy.
Smear test
A screening test where cells
from the surface of the cervix are
sampled, preserved immediately
and sent to the laboratory for
cytological analysis.
Smeartakers
A doctor or nurse who takes
smear tests.
Specimen
A sample of tissue removed
from the body for microscopic
examination.
37
Squamous cell carcinoma/
cancer
The most common form of
cervical cancer involving the
squamous cells.
Standard
A minimum requirement against
which performance can be
measured.
Transformation Zone (TZ)
The region of the cervix where the
columnar cells of the inner cervix
have or are changing to outer
squamous cells. The process of
change is called metaplasia. It is
the area most at risk of abnormal
change.
Treatment
A process aimed at the
eradication of cervical
abnormalities thus restoring
normal cytology and reducing the
chance of subsequent cancer by
90 per cent.
Unsatisfactory colposcopy
A term used to describe the
inability to visualise the whole
of the Transformation Zone
colposcopically.
Unsatisfactory/inadequate
smear test result
An ‘inadequate’ or ‘unsatisfactory’
smear test that cannot be
assessed by the cytology
laboratory.
GLOSSARY
1 September 2011 to 31 August 2012
CervicalCheck Programme Report 1 September 2011 to 31 August 2012
The National Cancer Screening Service is part of the Health
Service Executive. It encompasses BreastCheck – The National
Breast Screening Programme, CervicalCheck – The National
Cervical Screening Programme, BowelScreen – The National
Bowel Screening Programme and Diabetic RetinaScreen – The
National Diabetic Retinal Screening Programme
QA - CS/PR/PM-17 Rev 1
ISBN number: 978-1-907487-14-9
Programme
Report